Gut microbiota changes after metabolic surgery in adult diabetic patients with mild obesity: a randomised controlled trial

Diabetology & Metabolic Syndrome

Cidália Pina Vaz¹  Manuel Ferreira-Magalhães²  Isaac Barroso³  Eva Lau⁴  Maria Manuel Silva⁵  Davide Carvalho⁵  Paula Freitas⁵  Flora Correia⁶  Adelino Barbosa⁷  Paul Picq⁸  Eugeni Belda⁸  Edi Prifti⁹  Karine Clément^1,10  Isabel Miranda^1,11  Joel Doré^1,12 

[1] CINTESIS - Center for Health Technologies and Information Systems Research - Faculty of Medicine, University of Porto, Porto, Portugal;Department of Pathology, Division of Microbiology, Faculty of Medicine, University of Porto, Porto, Portugal;CINTESIS - Center for Health Technologies and Information Systems Research - Faculty of Medicine, University of Porto, Porto, Portugal;Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal;Department of Biochemistry, Centro Hospitalar de S. João, Porto, Portugal;EpiUnit – Instituto de Saúde Pública, University of Porto, Porto, Portugal;Department of Endocrinology and Nutrition, Centro Hospitalar de S. João, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal;CINTESIS - Center for Health Technologies and Information Systems Research - Faculty of Medicine, University of Porto, Porto, Portugal;Department of Endocrinology and Nutrition, Centro Hospitalar de S. João, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal;I3S – Instituto de Investigação e Inovação em Saúde, Faculty of Medicine, University of Porto, Porto, Portugal;Department of Nutrition, Centro Hospitalar de S. João, Porto, Portugal;Faculty of Nutrition and Food Science, Porto, Portugal;Department of Surgery, Centro Hospitalar de S. João, Porto, Portugal;Integromics, Institute of Cardiometabolism and Nutrition, ICAN, Paris, France;Integromics, Institute of Cardiometabolism and Nutrition, ICAN, Paris, France;Unité de Modélisation Mathématique et Informatique des Systèmes Complexes, IRD, Sorbonne Université, UMMISCO, Paris, France;Sorbonne Université, INSERM, NutriOmics Research Unit, Pitié-Salpêtrière Hopital, Paris, France;Surgery and Physiology, Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal;Université Paris-Saclay, INRA, MetaGenoPolis, AgroParisTech, MICALIS, 78350, Jouy-en-Josas, France;

关键词: Diabetes mellitus;    Insulin resistance;    Microbiome;    Roux-en-Y gastric bypass;    Weight loss;   

DOI  :  10.1186/s13098-021-00672-1

来源: Springer

【 摘 要 】

BackgroundRoux-en-Y gastric bypass (RYGB) surgery is one of the most efficient procedures for the treatment of obesity, also improving metabolic and inflammatory status, in patients with mild obesity. The underlying mechanisms have not been fully understood, but gut microbiota is hypothesized to play a key role. Our aim was to evaluate the association between gut microbiota changes and anthropometric, metabolic and inflammatory profiles after metabolic surgery compared with medical therapy, in type 2 diabetic (T2DM) adults with mild obesity (BMI 30–35 kg/m2).MethodsDM2 was an open-label, randomised controlled clinical trial (RCT: ISRCTN53984585) with 2 arms: (i) surgical, and (ii) medical. The main outcome was gut microbiota changes after: metabolic surgery (Roux-en-Y gastric bypass—RYGB) versus standard medical therapy. Secondary outcomes included anthropometric, metabolic and inflammatory profiles. Clinical visits, blood workup, and stool samples were collected at baseline and months (M)1, 3, 6, 12. Gut microbiota was profiled using 16S rRNA targeted sequencing.ResultsTwenty patients were included: 10 in surgical and 10 in medical arm. Anthropometric and metabolic comparative analysis favoured RYGB over medical arm. At M12, the percentage of weight loss was 25.5 vs. 4.9% (p < 0.001) and HbA1c was 6.2 vs. 7.7% (p < 0.001) respectively.We observed a continuous increase of genus richness after RYGB up until M12. In the medical arm, genus richness ended-up being significantly lower at M12. Composition analysis indicated significant changes of the overall microbial ecosystem (permanova p = 0.004, [R2 = 0.17]) during the follow-up period after RYGB. There was a strong association between improvement of anthropometric/metabolic/inflammatory biomarkers and increase in microbial richness and Proteobacterial lineages.ConclusionsThis was the first RCT studying composite clinical, analytic, and microbiome changes in T2DM patients with class 1 obesity after RYGB versus standard medical therapy. The remarkable phenotypic improvement after surgery occurred concomitantly with changes in the gut microbiome, but at a lower level.Trial registration: ISRCTN53984585

【 授权许可】

CC BY